Utilization Review Nurse Consultant – Oncology and Transplant

Job Description: • Conduct medical necessity reviews for oncology and transplant-related services, both inpatient and outpatient. • Collaborate with healthcare providers to gather and assess clinical documentation via phone and electronic systems. • Apply evidence-based clinical criteria and guidelines to authorize services or refer cases to Medical Directors when needed. • Navigate multiple computer systems efficiently while maintaining accurate and timely documentation. • Work primarily in a sedentary setting involving extended periods of sitting, talking, listening, and computer use. • Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements. Requirements: • Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges • Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review, or prior authorization • 3+ years of experience in Acute clinical Oncology or Oncology/Transplant • Strong decision-making skills and clinical judgment in independent scenarios • Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms • Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation • 1+ years of Managed Care (MCO) preferred • 1+ years of experience working in a high-volume clinical call center environment • NCCN (National Comprehensive Cancer Network) guideline experience/exposure • Remote work experience Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings • Tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access • Many other benefits depending on eligibility Apply tot his job Apply To this Job